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This Article Full Text (PDF) All Versions of this Article: chest.07-2669v1 133/5/1174    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Uchiyama, H. Articles by Chida, K. PubMed PubMed Citation Articles by Uchiyama, H. Articles by Chida, K.

Alterations in smoking habits are associated with acute eosinophilic pneumonia

^*Department of Internal Medicine, National Hospital Organization Tenryu Hospital, 1-20-1 Handayama, Hamamatsu, Shizuoka, JAPAN 2nd Division, Department of Internal Medicine, Hamamatsu University School of Medicine

suda{at}hama-med.ac.jp

Abstract

Background: Acute eosinophilic pneumonia (AEP) is characterized by a febrile illness, diffuse pulmonary infiltrates, and pulmonary eosinophilia. The etiology of AEP remains unknown, but several studies have proposed a relationship between cigarette smoking and AEP. However, most studies showing this possibility were single-case reports, and cigarette smoke has not been fully validated as a causative agent of AEP in a large series of patients. The present study was conducted to clarify the etiologic role of cigarette smoking in AEP, with special reference to alterations in smoking habits.

Methods: We took a detailed history of smoking habits before AEP onset in 33 patients with AEP, and performed a cigarette smoke provocation test.

Results: Of our AEP patients, all but one (97%) were current smokers. Interestingly, 21 of these were new-onset smokers, and 2 had restarted smoking after a 1-2-year cessation of smoking. The duration between starting smoking and AEP onset was within one month (0.67±0.53 months). Additionally, 6 of the remaining smokers had increased the quantity of cigarettes smoked daily, 4-5 fold, mostly within the month before AEP onset (0.81±0.58 months). Only 3 smokers had not changed their smoking habits before AEP onset. Cigarette smoke provocation tests revealed positive results in all 9 patients tested.

Conclusion: These data suggest that recent alterations in smoking habits, not only beginning to smoke, but also restarting to smoke and increasing daily smoking doses, are associated with the development of AEP.

Key Words: acute eosinophilic pneumonia • provocation test